Is It Migraine or Trigeminal Neuralgia?

Question:

Dear Dr. Watson and Teri,

I’m writing to you hoping you can help clear up some confusion. I was diagnosed with Migraine without aura about 15 years ago when I was just 13. When I have a Migraine, I get nausea and extreme sensitivity to light along with the headache. My head and face are also painful to touch during a Migraine, and I thought that was allodynia from what I’ve read on HealthCentral. Here’s where the confusion comes in. My new family doctor looked through my medical history and told me I have trigeminal neuralgia along with Migraines because of my head and face being painful to touch. He wants me to start taking gabapentin every day for trigeminal neuralgia. The problem is that I’m not convinced of the diagnosis. I only have that sensitivity during a Migraine attack. If it was trigeminal neuralgia, wouldn’t it happen at other times too? Thank you, Emily.

Answer:

Dear Emily;

As you can understand, we can’t know if your doctor is correct in his diagnosis. That said, we can give you some information and support.

Your logic is easy to follow. Yes, it would seem that you should experience the sensitivity to your head and face at times other than during Migraine attacks if it is indeed trigeminal neuralgia. And yes, allodynia could account for it during your Migraine attacks.

Although it doesn’t rule it out, you’re on the young side for trigeminal neuralgia as it usually occurs in women over 50. Is your family doctor treating your Migraines? If you see a different doctor for Migraine, getting him or her and your family doctor to consult could help with this situation. If they disagree, and since you’re clearly not comfortable with the diagnosis of trigeminal neuralgia, there’s nothing wrong with getting another opinion. You might find it beneficial to seek another opinion from a Migraine and headache specialist. You can find more on this in our article Why, How, and Where to Find a Migraine Specialist.

Thank you for your question,

Dave Watson and Teri Robert

About Ask the Clinician:

If you have a question, please go to our submission form. Accepted questions will be answered by publishing the answers in our column. Due to the number of questions submitted, no questions will be answered privately, and questions will be accepted only when submitted via THIS FORM. Please do not submit questions via email, private message, or blog comments. Thank you.

Please note: We cannot diagnose, suggest specific treatment, or handle emergencies via the Internet. Please do not ask us to diagnose; see your physician for diagnosis. For an overview of how we can help and questions we can and can't answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.

We hope you find this general medical and health information useful, but this Q & A is meant to support not replace the professional medical advice you receive from your doctor. For all personal medical and health matters, including decisions about diagnoses, medications, and other treatment options, you should always consult your doctor.